Sam L Pettibon
Rehabilitation Chiropractor
30804 Pacific Hwy S
Federal Way
, Washington 98003-4902
Sam L Pettibon
Rehabilitation Chiropractor
30804 Pacific Hwy S
Federal Way
, Washington 98003-4902
(253) 839-2625
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About
Features
Specialties
- Rehabilitation Chiropractor
Languages spoken
- English
Location
First Address
- Sam L Pettibon
- 30804 Pacific Hwy S
- Federal Way, WA
- Zip : 98003-4902
- Fax : (253) 839-2625
- Phone : (253) 839-5644
Second Address
- Sam L Pettibon
- 30804 Pacific Hwy S
- Federal Way, WA
- Zip : 98003-4902
- Fax : (253) 839-2625
- Phone : (253) 839-5644
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 111NR0400X | Rehabilitation Chiropractor | 2174 | WA |
National Provider Identifier
| NPI | 1386860492 |
|---|---|
| Provider Name | Sam L Pettibon |
| First Address | Federal Way, WA 98003-4902 |
| Second Address | Federal Way, WA 98003-4902 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 17/04/2007 |
| Last Update Date | 02/05/2012 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 2007078 | (05) | WA |
| 73321 | L & I PROVIDER (01) | WA |
| PE5678 | REGENCE INSURANCE PROVIDE (01) | WA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.